Prognostic Effect of Guideline-Directed Therapy Is More Noticeable Early in the Course of Heart Failure

Ahn Min-Soo; Yoo Byung-Su; Yoon JunghanLee Seung-HwanKim Jang-YoungAhn Sung GyunYoun Young JinLee Jun-WonSon Jung-WooKim Hye SimKang Dae RyongLee Sang EunCho Hyun-JaiLee Hae-YoungJeon Eun-SeokKang Seok-MinChoi Dong-JuCho Myeong-Chan

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Prognostic Effect of Guideline-Directed Therapy Is More Noticeable Early in the Course of Heart Failure

机译：Prognostic Effect of Guideline-Directed Therapy Is More Noticeable Early in the Course of Heart Failure

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Background There have been few studies to evaluate the prognostic implications of guideline-directed therapy according to the temporal course of heart failure. This study assessed the relationship between adherence to guideline-directed therapy at discharge and 60-day clinical outcomes in de novo acute heart failure (AHF) and acute decompensated chronic heart failure (ADCHF) separately. Methods Among 5,625 AHF patients who were recruited from a multicenter cohort registry of Korean Acute Heart Failure, 2,769 patients with reduced ejection fraction were analyzed. Guideline-directed therapies were defined as the use of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor II blocker (ARB), β-blocker, and mineralocorticoid receptor antagonist. Results In de novo AHF, ACEI or ARB reduced re-hospitalization (hazard ratio HR, 0.57; 95 confidence interval CI, 0.34–0.95), mortality (HR, 0.41; 95 CI, 0.24–0.69) and composite endpoint (HR, 0.52; 95 CI, 0.36–0.77) rates. Beta-blockers reduced re-hospitalization (HR, 0.62; 95 CI, 0.41–0.95) and composite endpoint (HR, 0.65; 95 CI, 0.47–0.90) rates. In ADCHF, adherence to ACEI or ARB was associated with only mortality and β-blockers with composite endpoint. Conclusion The prognostic implications of adherence to guideline-directed therapy at discharge were more pronounced in de novo heart failure. We recommend that guideline-directed therapy be started as early as possible in the course of heart failure with reduced ejection fraction.

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《Journal of Korean medical science.》 |2019年第17期|1-12|共12页
作者
Ahn Min-Soo; Yoo Byung-Su; Yoon JunghanLee Seung-HwanKim Jang-YoungAhn Sung GyunYoun Young JinLee Jun-WonSon Jung-WooKim Hye SimKang Dae RyongLee Sang EunCho Hyun-JaiLee Hae-YoungJeon Eun-SeokKang Seok-MinChoi Dong-JuCho Myeong-Chan;
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作者单位

Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University, Wonju College of Medicine;

Center of Biomedical Data Science, Yonsei University, Wonju College of Medicine;

Department of Internal Medicine, Seoul National University HospitalDepartment of Internal Medicine, Samsung Medical Center, School of Medicine, Sungkyunkwan UniversityDepartment of Internal Medicine, Severance Hospital, Yonsei University College of MedicineDepartment of Internal Medicine, Seoul National University Bundang HospitalDepartment of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine;

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正文语种英语
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De Novo Acute Heart Failure; Acute Decompensated Heart Failure; Guideline-Directed Therapy;

Prognostic Effect of Guideline-Directed Therapy Is More Noticeable Early in the Course of Heart Failure

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